Information for journalists
We welcome any interest in the condition from journalists. Feel free to use information on the site, all of which is backed by research (unless otherwise stated). Please cite us as your source if you do this and put details of our website address in the copy. We are also happy to check copy of any articles written to ensure that the information is accurate and up to date.
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We are able to provide case studies for articles on ICP. Please contact Jenny Chambers (firstname.lastname@example.org) if you would like to be put in touch with someone who has been affected by the condition.
Intrahepatic cholestasis of pregnancy (also known as obstetric cholestasis, or OC) affects 1 in 140 women (0.7%, or around 5,500 women) in the UK every year.
The cause of ICP is not fully understood but is likely to be multifactorial:
- Hormones are implicated, as women expecting twins (or more, e.g. triplets) seem to be predisposed towards developing the condition, as are women who have had IVF.
- The condition has a genetic component, as researchers know that mothers, daughters and sisters of affected women have a higher than average risk of being affected. Research has so far identified several gene mutations involved in ICP.
- The condition appears to have a seasonal trend, with higher numbers in the winter months than in summer, suggesting that environmental factors such as sunlight or diet could be implicated.
Main symptoms include:
- Itching – often on the hands and feet, but it can occur anywhere on the body and is typically worse at night. It can range in intensity from mild to so severe that the woman scratches herself until she breaks the skin and makes herself bleed.
- Dark urine – women often report that their urine becomes darker.
- Pale stools – a small number of women develop pale stools (also known as steatorrhea).
- It usually presents in the third trimester of pregnancy, but can be earlier (as early as the first trimester).
- It is possible to itch for some time before liver functions tests show any abnormalities or bile acid levels become elevated.
It should be diagnosed by:
- Blood tests: liver function test and bile acids levels. The latter are essential for diagnosis, as around 20% of women with ICP will have normal liver function test results.
- Excluding other possible causes such as autoimmune hepatitis, PBC (primary biliary cholangitis) and other liver disorders.
It is associated with:
- Meconium staining of the amniotic fluid.
- Spontaneous premature labour.
- Fetal distress.
- In severe cases, stillbirth (associated with high bile acid levels).
It has typically been treated and managed by:
- Prescribing medication such as ursodeoxycholic acid (in a recent trial called PITCHES this drug has been shown to be ineffective in the treatment of ICP). In severe cases, some specialists have been using rifampicin (although this drug should only be given in conjunction with specialist advice). A new trial, called TURRIFIC, is currently under way in Australia to evaluate its efficacy. ICP Support is a collaborator on this study.
- Delivering the baby at around 37–38 weeks has previously been thought to be best practice, but new research by Ovadia et al 2019 has shown that induction can be delayed to 39 weeks. However, those women with very severe ICP may need to be induced as early as 34–35 weeks of pregnancy.
The information above is based on the following list of selected academic publications about ICP.
Abedin P, Weaver JB, Egginton E. Intrahepatic cholestasis of pregnancy: prevalence and ethnic distribution. Ethn Health 1999; 4: 35–37
Chappell LC, Gurung V, Seed PT, Chambers J, Williamson C, Thornton JG. Ursodeoxycholic acid versus placebo, and early term delivery versus expectant management, in women with intrahepatic cholestasis of pregnancy: semifactorial randomised clinical trial. BMJ 2012; 344 doi: 10.1136/bmj.e3799
Chappell LC, Bell JL, Smith A, Linsell L, Juszczak E, Dixon PH, Chambers J, Hunter R, Dorling J, Williamson C, Thornton JG. Ursodeoxycholic acid versus placebo in women with intrahepatic cholestasis of pregnancy (PITCHES): a randomised controlled trial. The Lancet 2019; https://doi.org/10.1016/S0140-6736(19)31270-X.
Dixon PH, van Mil SW, Chambers J, Strautnieks S, Thompson RJ, Lammert F, Kubitz R, Keitel V, Glantz A, Mattsson LA, Marschall HU, Molokhia M, Moore GE, Linton KJ, Williamson C. Contribution of variant alleles of ABCB11 to susceptibility to intrahepatic cholestasis of pregnancy. Gut 2009; 58: 537–544
Dixon PH, Williamson C. The molecular genetics of intrahepatic cholestasis of pregnancy. Obstet Med 2008; 1: 65–71
Fisk NM, Story GM. Fetal outcome in obstetric cholestasis. Br J Obstet Gynaecol 1988; 95 1137–1143
Geenes V, Williamson C. Intrahepatic cholestasis of pregnancy. World J Gastroenterol 2009 May 7; 15(17): 2049–2066
Glantz A, Marschall HU, Mattsson LA. Intrahepatic cholestasis of pregnancy: relationships between bile acid levels and fetal complication rates. Hepatology 2004; 40: 467–474
Heikkinen J. Serum bile acids in the early diagnosis of intrahepatic cholestasis of pregnancy. Obstet Gynecol 1983.
Kenyon AP, Piercy CN, Girling J, Williamson C, Tribe RM, Shennan AH. Obstetric cholestasis, outcome with active management: a series of 70 cases. BJOG 2002; 109: 282–288
Laatikainen T, Ikonen E. Fetal prognosis in obstetric hepatosis. Ann Chir Gynaecol Fenn 1975; 64: 155–164
Laatikainen T, Tulenheimo A. Maternal serum bile acid levels and fetal distress in cholestasis of pregnancy. Int J Gynaecol Obstet 1984; 22: 91–94
Lee RH, Kwok KM, Ingles S, Wilson ML, Mullin P, Incerpi M, Pathak B, Goodwin TM. Pregnancy outcomes during an era of aggressive management for intrahepatic cholestasis of pregnancy. Am J Perinatol 2008; 25: 341–345
Marschall HU, Wagner M, Zollner G, Fickert P, Diczfalusy U, Gumhold J, Silbert D, Fuchsbichler A, Benthin L, Grundström R, Gustafsson U, Sahlin S, Einarsson C, Trauner M. Complementary stimulation of hepatobiliary transport and detoxification systems by rifampicin and ursodeoxycholic acid in humans. Gastroenterology 2005; 129: 476–485
Ovadia C, Seed PT, Sklavounos A, Geenes V, Di Illio C, Chambers J et al. Association of adverse perinatal outcomes of intrahepatic cholestasis of pregnancy with biochemical markers: results of aggregate and individual patient data meta-analyses. The Lancet 2019; DOI: http://dx.doi.org/10.1016/S0140-6736(18)31877-4.
Palma J, Reyes H, Ribalta J, Iglesias J, Gonzalez MC, Hernandez I, Alvarez C, Molina C, Danitz AM. Effects of ursodeoxycholic acid in patients with intrahepatic cholestasis of pregnancy. Hepatology 1992; 15: 1043–1047
Reid R, Ivey KJ, Rencoret RH, Storey B. Fetal complications of obstetric cholestasis. Br Med J 1976; 1: 870–872
Reyes, H. Sex hormones and bile acids in intrahepatic cholestasis of pregnancy. Hepatology 2008; 47: 376–379
Roncaglia N, Arreghini A, Locatelli A, Bellini P, Andreotti C, Ghidini A. Obstetric cholestasis: outcome with active management. Eur J Obstet Gynecol Reprod Biol 2002; 100: 167–170
Saleh M, Abdo K. Consensus on the management of obstetric cholestasis: National UK survey. BJOG 2007; 114: 99–103
Sjövall K, Sjövall J. Serum bile acid levels in pregnancy with pruritus (bile acids and steroids 158). Clin Chim Acta 1966; 13: 207–211
Walker IA, Nelson-Piercy C, Williamson C. Role of bile acid measurement in pregnancy. Ann Clin Biochem 2002; 39: 105–113
Williamson C, Geenes V Intrahepatic cholestasis of pregnancy. Obstet Gynecol 2014; 124:120–133. DOI: 10.1097/AOG.0000000000000346.
Williamson C, Hems LM, Goulis DG, Walker I, Chambers J, Donaldson O, Swiet M, Johnston DG. Clinical outcome in a series of cases of obstetric cholestasis identified via a patient support group. BJOG 2004; 111: 676–681